TY - JOUR
T1 - Endoscopic Ultrasound as a Pretreatment Clinical Staging Tool for Gastric Cancer
T2 - Association with Pathology and Outcome
AU - Merkow, Ryan P.
AU - Herrera, Gabriel
AU - Goldman, Debra A.
AU - Gerdes, Hans
AU - Schattner, Mark A.
AU - Markowitz, Arnold J.
AU - Strong, Vivian E.
AU - Brennan, Murray F.
AU - Coit, Daniel G.
N1 - Funding Information:
FUNDING This study was supported in part by National Institutes of Health/National Cancer Institute (NIH/NCI) Grant P30 CA008748 (Cancer Center Support Grant).
Publisher Copyright:
© 2017, Society of Surgical Oncology.
PY - 2017/8/16
Y1 - 2017/8/16
N2 - Background: Endoscopic ultrasound (EUS) is a guideline-recommended diagnostic test to estimate pretreatment clinical stage in gastric cancer. The impact of EUS to discriminate long-term outcomes has not been established. Objectives: The objectives of our study were to (1) evaluate the association between EUS and pathologic stage; (2) evaluate the ability of EUS to predict disease-specific survival (DSS); and (3) determine how neoadjuvant chemotherapy (NCT) affects these relationships. Methods: A prospective gastric cancer database at a tertiary care cancer center identified 734 patients who underwent curative intent resection. Patients were separated into EUS low-risk (T1–2, N0) and EUS high-risk (T3–4 Nany, or Tany N+) groups. Agreement statistics and 5-year DSS were estimated stratified by NCT. Results: Between 1987 and 2015, 68% (502/734) of patients were not treated with NCT. Among these patients, percentage agreement between EUS and pathology was moderate (individual T stage: 52%; N stage: 70%; risk group: 73%). EUS accurately estimated pathologic risk group in 73% (365/502) of patients, whereas it overestimated pathologic risk group in 19% (93/502) of patients and underestimated risk in 8% (41/502) of patients. EUS in non-NCT staging was able to discriminate DSS for T stage (hazard ratio [HR] 5.07, p < 0.05), N stage (HR 3.58, p < 0.05), and risk group (HR 6.35, p < 0.05). Among patients treated with NCT, EUS was unable to discriminate DSS for T stage (HR 0.94, p > 0.05), N stage (HR 1.46, p > 0.05) and risk group (HR 0.50, p > 0.05). Conclusions: Pretreatment clinical staging based on EUS alone could lead to over- or under treatment in 27% of patients and can discriminate DSS in NCT-naive patients. EUS should be used in the context of other validated clinical risk tools.
AB - Background: Endoscopic ultrasound (EUS) is a guideline-recommended diagnostic test to estimate pretreatment clinical stage in gastric cancer. The impact of EUS to discriminate long-term outcomes has not been established. Objectives: The objectives of our study were to (1) evaluate the association between EUS and pathologic stage; (2) evaluate the ability of EUS to predict disease-specific survival (DSS); and (3) determine how neoadjuvant chemotherapy (NCT) affects these relationships. Methods: A prospective gastric cancer database at a tertiary care cancer center identified 734 patients who underwent curative intent resection. Patients were separated into EUS low-risk (T1–2, N0) and EUS high-risk (T3–4 Nany, or Tany N+) groups. Agreement statistics and 5-year DSS were estimated stratified by NCT. Results: Between 1987 and 2015, 68% (502/734) of patients were not treated with NCT. Among these patients, percentage agreement between EUS and pathology was moderate (individual T stage: 52%; N stage: 70%; risk group: 73%). EUS accurately estimated pathologic risk group in 73% (365/502) of patients, whereas it overestimated pathologic risk group in 19% (93/502) of patients and underestimated risk in 8% (41/502) of patients. EUS in non-NCT staging was able to discriminate DSS for T stage (hazard ratio [HR] 5.07, p < 0.05), N stage (HR 3.58, p < 0.05), and risk group (HR 6.35, p < 0.05). Among patients treated with NCT, EUS was unable to discriminate DSS for T stage (HR 0.94, p > 0.05), N stage (HR 1.46, p > 0.05) and risk group (HR 0.50, p > 0.05). Conclusions: Pretreatment clinical staging based on EUS alone could lead to over- or under treatment in 27% of patients and can discriminate DSS in NCT-naive patients. EUS should be used in the context of other validated clinical risk tools.
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U2 - 10.1245/s10434-017-6050-9
DO - 10.1245/s10434-017-6050-9
M3 - Article
C2 - 28815443
AN - SCOPUS:85027525689
SN - 1068-9265
VL - 24
SP - 1
EP - 9
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 12
ER -